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Biomedical subjects

I Morrison

Publications and source records attributed to I Morrison.

At least 55 records · Page 3Linked to original sources
PubMed1991

Assessment of fetal well-being with ultrasound.

The practice of medicine is undergoing marked changes fueled by the infusion of vast amounts of new information concerning the etiology, the progressive pathophysiology, and the complexity of host response to disease states. It is only recently that we have begun to examine the present extent of fetal disease and to determine the characteristics of its advancements. This information now permits new and rational approaches to the management of fetal disease. Clinical significance, both real and potential, of this new wealth of information in reducing perinatal mortality and morbidity is difficult to overestimate. Cumulative experience with fetal biophysical scoring as a method for antepartum fetal risk assessment is now extensive. The cumulative data indicate that the method is sensitive for recognizing both the normal and the compromised fetus. Moreover, the method appears to offer the advantage of grading various degrees of fetal compromise. The additional information gained by real-time ultrasound scanning (gestational age determination, fetal morphometrics, and fetal anomaly screening), although not an integral part of the fetal biophysical profile score, nevertheless remains a critical aspect of antepartum fetal assessment. These data are collected simultaneously with fetal biophysical profile scoring. It is impossible to separate cleanly the advantage of fetal biophysical profile scoring in isolation of this additional information. It would, however, seem that such attempt at separation is artificial because the data in combination provide the key information that the physician needs to guide fetal management. It seems more reasonable to expect that continued modification and improvement of the existing fetal biophysical profile scoring method with inclusion of new testing techniques will be the steps that will occur to improve testing accuracy (Fig. 3). In medical schools in the 1960s, it was generally taught that the concept of "irreducible" perinatal mortality existed and that this figure was usually set at a perinatal mortality of around 8 per 1000. Now in the 1990s that perinatal mortality has already fallen below this irreducible level and continues to fall. We now observe perinatal mortality among tested fetuses of less than 7 per 1000 and corrected perinatal mortalities of less than 2 per 1000. These remarkable results strongly underscore the advantages obtained by ultrasound assessment of the fetus.

Amniotic Fluid↗
PubMed1990

Fetal assessment based on fetal biophysical profile scoring. III. Positive predictive accuracy of the very abnormal test (biophysical profile score = 0).

The relationship between complete absence of all components of the fetal biophysical profile score (biophysical profile score = 0) and adverse perinatal outcome was examined. Twenty-nine of 28,655 fetuses studied (0.092%) had a last biophysical profile score of 0; 48.3% of these perinates died (14 of 29 fetuses), the majority of whom (11 of 14) were stillborn, with death occurring as early as 30 minutes to as long as 11 days after the last test. Three asphyxia-related neonatal deaths occurred despite aggressive and immediate intervention. All survivors exhibited at least one of the five discrete markers used to assess perinatal morbidity. The positive predictive accuracy of a biophysical profile score of 0, with mortality and morbidity used as end points, was 100%. These data indicate the very abnormal fetal biophysical profile score to be a perinatal emergency.

Acidosis↗
PubMed1990

Fetal assessment based on fetal biophysical profile scoring. IV. An analysis of perinatal morbidity and mortality.

The relationship between the last biophysical profile score result and perinatal outcome was determined among a large referred population of high-risk pregnancies. A highly significant inverse linear correlation was observed for fetal distress, admission to neonatal intensive care unit, intrauterine growth retardation, 5-minute Apgar score less than 7, and umbilical cord pH less than 7.20 but not for the incidence of meconium or major anomaly. A highly significant inverse exponential (log 10) relationship was observed for perinatal mortality in total and by component parts and cause. These data strongly suggest the biophysical profile scoring method of fetal risk assessment is accurate and also provides insight into the extent of fetal compromise.

Female↗
PubMed1990

The abnormal fetal biophysical profile score. V. Predictive accuracy according to score composition.

The relationship between last abnormal biophysical profile score, in total and by variable composition, and a spectra of abnormal perinatal outcome end points was examined in 525 fetuses. Highly significant inverse relationships between last test score and outcome were observed; relationships were linear for most end points and exponential for perinatal mortality end points. For biophysical profile scores less than or equal to 6, 25 of the 26 possible variable combinations were observed, at varying frequencies. For a biophysical profile score of 6, the positive predictive accuracy for some end points was significantly higher with either nonreactive nonstress test/fetal tone absent or nonreactive nonstress test/absent fetal breathing movement, and significantly lower with absent fetal breathing movement and decreased amniotic fluid volume. For a biophysical profile score of 4, the positive predictive accuracy for some end points was significantly higher with nonreactive nonstress test/absent fetal breathing movement/decreased amniotic fluid and was significantly lower with absent fetal movement/fetal breathing movement/fetal tone. No significant variation was observed for a biophysical profile score of 2. These data indicate that not all abnormal biophysical profile scores are equal.

Apgar Score↗
PubMed1989

Severe fetal brain injury without evident intrapartum asphyxia or trauma.

Two appropriate-for-dates term infants were born after uncomplicated labors and atraumatic deliveries. They were depressed at birth, developed seizures on the first day of life, and followed clinical courses compatible with hypoxic-ischemic encephalopathy. However, the umbilical cord vessel pH and blood gases were normal. The children are now severely retarded and have cerebral palsy. These cases prove that the events of labor and delivery may not be responsible for all cases of brain damage in surviving children.

Adolescent↗